两种非融合术式治疗Ⅱ型和Ⅱa型Hangman骨折的疗效比较

Comparison of the Efficacy of Two Non-fused Treatments for TypeⅡand TypeⅡa Hangman Fractures

目的比较后路C_(2)椎弓根螺钉+“Ω”形横连内固定术与后路C_(1~3)非融合固定术后行二期内固定取出术,这两种非融合术式治疗Ⅱ型和Ⅱa型Hangman骨折的疗效。方法回顾性分析2015年3月至2021年7月在中国人民解放军联勤保障部队第九〇四医院行不同手术方式治疗的37例Ⅱ型和Ⅱa型Hangman骨折患者。A组16例,男11例,女5例;年龄29~65岁,平均(45.6±10.2)岁;患者接受后路C_(2)椎弓根螺钉+“Ω”形横连内固定术。B组21例,男14例,女7例;年龄30~63岁,平均(45.5±9.3)岁;患者接受后路C_(1~3)非融合固定术后行二期内固定取出术。记录并比较两组的手术时间、术中出血量、住院天数、住院费用和骨折愈合时间,以及患者术前和末次随访时的疼痛视觉模拟评分(visual analoue scale,VAS)、颈椎功能障碍指数(neck disabilitv index,NDI)与颈椎总旋转度,并进行组间比较。结果两组患者末次随访时的枕颈部疼痛、颈椎活动受限等临床症状均较术前明显改善。A组手术时间为(67.2±11.1)min,术中失血量为(65.6±18.3)mL,住院时间为(10.6±1.4)d,住院费用为(3.5±0.5)万元;B组手术时间为(118.6±17.8)min,术中失血量为(106.7±25.2)mL,住院时间为(15.1±1.2)d,住院费用为(7.4±0.5)万元。两组手术时间、出血量、住院时间及住院费用比较差异均有统计学意义(P<0.01)。A组骨折愈合时间为(9.0±2.3)个月,B组骨折愈合时间为(9.1±2.3)个月,两组比较差异无统计学意义(P>0.05)。两组末次随访时VAS评分、NDI均较术前明显改善,差异具有统计学意义(P<0.01)。A组末次随访VAS评分和NDI分别为(1.6±0.7)分、(2.3±1.1)%,B组为(2.1±0.7)分、(3.7±1.8)%,组间比较差异均有统计学意义(P<0.05)。A组末次随访时的颈椎总旋转度为(138.1±7.8)°,B组内固定拆除前颈椎总旋转度为(77.4±8.7)°,末次随访时颈椎总旋转度为(125.9±11.9)°,组间比较差异均有统计学意义(P<0.05)。结论后路C_(2)椎弓根螺钉+“Ω”形横连内固定术与后路C_(1~3)非融合固定术治疗Ⅱ型和Ⅱa型Hangman骨折临床疗效均确切,但单节段固定更有利于颈椎运动节段的保留。

Objective To compare the efficacy of posterior C_(2) pedicle screw+“Ω”transverse internal fixation and posterior C_(1~3) non-fusion fixation followed by two-stage internal fixation removal in the treatment of typeⅡand typeⅡa Hangman fractures.Methods A total of 37 patients with Hangman fracture who underwent different surgical methods in 904 Hospital of the joint logistics support force of the Chinese people's Liberation Army from March 2015 to July 2021 were retrospectively analyzed.In Group A,16 patients(male 11,female 5),aged from 29 to 65(45.6±10.2)years,underwent posterior C_(2) pedicle screw plus“Ω”shaped transverse fixation.In Group B,21 patients(male 14,female 7)were treated.The Age ranged from 30 to 63 years(45.5±9.3)years.The operation time,intraoperative blood loss,hospital stay,hospitalization costs and fracture healing time,visual analogue scale(VAS),neck disability index(NDI)and total cervical rotation at follow-up were recorded and compared between the two groups.Results The clinical symptoms of occipitocervical pain and limited cervical movement were significantly improved during follow-up in both groups.In group A,the operation time was(67.2±11.1)min,intraoperative blood loss was(65.6±18.3)mL,hospital stay was(10.6±1.4)d,and hospitalization cost was(3.5±0.5)0000 yuan.In group B,the operation time was(118.6±17.8)min,intraoperative blood loss was(106.7±25.2)mL,hospital stay was(15.1±1.2)d,and hospitalization cost was(7.4±0.5)000 yuan.The differences in the operation time,blood loss,hospital stay and hospitalization costs between the two groups had statistical significance(P<0.01).A group of fracture healing time was(9.0±2.3)month,and B group fracture healing time was(9.1±2.3)month,and the difference between the two groups had no statistical significance(P>0.05).The VAS score and NDI at follow-up were significantly improved in both groups,and the differences were statistically significant(P<0.01).The VAS score and NDI of group A were(1.6±0.7)points and(2.3±1.1)%,respectively,while those of group B were(2.1±0.7)points and(3.7±1.8)%,respectively.There was significant difference between the two groups(P<0.05).The total rotation of cervical vertebra was(138.1±7.8)°during follow-up in group A,(77.4±8.7)°before internal fixation removal in group B,and(125.9±11.9)°during follow-up,and the differences had statistical significance(P<0.05).Conclusion Both posterior C_(2) pedicle screw+“Ω”transverse internal fixation and posterior C_(1~3) non-fusion fixation are effective in the treatment of typeⅡand typeⅡa Hangman fractures,but single-level fixation is more beneficial to the preservation of cervical movement.